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Complications in the femoral area following vascular surgery are frequent and linked to considerable morbidity, including the risk of underlying graft infection. Sartorius muscle flaps are an important adjunct for the treatment of wound complications. In this study, we examined our experience with prophylactic sartorius muscle flap coverage and its association with prosthetic vascular graft infection. In this single-center analysis, electronic medical records were retrospectively reviewed for all sartorius muscle flap procedures performed from 2012 to 2021. Prophylactic indication was defined as flap reconstruction during index revascularization in the absence of active inguinal infection. Over the 9-y period, a total of 54 prophylactic sartorius flaps were performed in 47 patients. The median patient age was 66 y (interquartile range [IQR] 61-77 y). Wound complications requiring reintervention occurred in 16 (29.6%) patients, including 6 (11.1%) surgical site infections, 5 (9.3%) wound dehiscence, and 5 (9.3%) infected seromata. Among patients suffering wound complications, 30-d readmission (75.0% versus 26.3%, P = 0.004) and reoperative flap creation rates (25.0% versus 2.6%, P = 0.010) were higher, whereas 30-d mortality rates (0.0% versus 5.3%, P = 0.51) were similar. Only one patient (1.9%) developed vascular graft infection over a median follow-up period of 2.4 y (IQR 0.9-4.0 y). On multivariate analysis, body mass index (adjusted odds ratio 1.23, 95% confidence interval, 1.12-1.35, P = 0.023) was associated with reoperative wound complications. Wound complications were common after prophylactic sartorius flap creation in this high-risk population; however, infection of the underlying vascular graft was rare. These data suggest that sartorius flap may be effective in a prophylactic role. [ABSTRACT FROM AUTHOR]

Background Though infrequent, allograft nephrectomies are performed for early and late graft loss. The study aims to analyze the histopathologic characteristics of allograft nephrectomy specimens. Materials and Methods We conducted an observational study of 103 cases of allograft nephrectomies from 21 centers from 2013 to 2023. All the pathology slides, including hematoxylin and eosin-stained sections, masson trichrome, jones methenamine silver, PAS, GMS, AFB, and immunohistochemistry (C4d, SV40) were reviewed. Pathologic findings were analyzed based on the transplant to nephrectomy interval (0–3 months, > 3 months) and type of donor (deceased, live donor). Results Of the total 103 cases, 77 were male. The mean age at the time of nephrectomy was 36.4 (range 5–64) years. The allografts were obtained from deceased (57) donors and live related (46) donors. Graft tenderness, oliguria/anuria, and fever were common clinical presentations. The majority (71.8%) of the nephrectomies were performed within the first 3 months of renal transplant. Renal vessel thrombosis (32.03%) was the most common pathologic finding. Infections were more common in the first 3 months after the transplant. Fungal infection had a significant association with deceased donor transplantation (p = 0.029). Conclusion Histopathological study of allograft nephrectomy specimens aids understanding of graft loss causes. The study also provides opportunities to prevent complications and implement measures to prolong graft survival in a subsequent transplant. [ABSTRACT FROM AUTHOR]

Background/Objectives: Vascular graft infections (VGIs) represent a life-threatening complication, occurring in 0.2–6% of patients following aortic prosthetic placements. Historically, the primary focus for reducing VGIs has been on prevention. Currently, antimicrobial grafts are not available on the market. This study aimed to evaluate the efficacy of combining two antibiotics, fosfomycin and oritavancin, impregnated into the commercially available GelweaveTM vascular graft as a prophylactic alternative against the most commonly implicated bacteria responsible for VGI. Methods: The antimicrobial activity of fosfomycin and oritavancin was assessed using the broth microdilution method, and a synergistic effect was demonstrated using the checkerboard assay against Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant Enterococcus faecium. The antibiotics were impregnated into the commercial vascular graft through immersion, and the antimicrobial efficacy of the fosfomycin/oritavancin-impregnated graft was assessed over a period of 7 days. Results: Eradication of all microorganisms tested was achieved using impregnation solutions with concentrations of 40 mg/mL of fosfomycin and 256 µg/mL of oritavancin. Conclusions: Impregnation with the combination of fosfomycin/oritavancin proved to be a promising approach to prevent VGIs. Vascular grafts with impregnated antibiotics are not yet available on the market, and this work represents an important step toward the development of a new class of antimicrobial vascular grafts. [ABSTRACT FROM AUTHOR]

OBJECTIVES We conducted this case series to evaluate the feasibility and mid-term outcomes of orthotopic aortic arch reconstruction using xenopericardial grafts to treat native aortic arch/arch graft infection. METHODS Between 2010 and 2023, adopting a multidisciplinary approach, we treated consecutive patients with aortic arch/arch graft infection by orthotopic branched xenopericardial roll graft replacement and tissue filling. The end points of the study were the graft reinfection and graft-related complications such as pseudoaneurysm formation, thromboembolism, graft stenosis, graft calcification and death. RESULTS The subjects were 11 patients (8 men and 3 women) with a median age of 66 [51–79, (interquartile range) 59.0, 70.5] years. Of the 11 patients, 7 underwent preoperative mediastinal irrigation/negative-pressure wound treatment. The 30-day mortality was 0% (0/11 patients), and 1 patient died in the hospital after 8 months. Aorta-related death occurred in 18.2% (2/11 patients), with both cases developing local recurrence of fungal infection. The remaining 9 patients (81.8%) remained free of reinfection. The estimated 1-, 3-, 5- and 7-year risk-adjusted survival rates were 91 ± 9%, 81 ± 12%, 58 ± 16% and 58 ± 16%, respectively. The estimated 1-, 3-, 5- and 7-year cumulative aorta-related mortality rates were 9 ± 9%, 19 ± 12%, 19 ± 12% and 19 ± 12%, respectively. Graft-related complications included branch kinking in 1 patient and graft rupture in 1 patient. There were no cases of graft-related thromboembolism or graft calcification. The median follow-up period was 45 [8–101, (interquartile range) 36.5, 70.9] months. The longest follow-up period until date of the currently surviving patients is 101 months. CONCLUSIONS Although the xenopericardium appeared to be vulnerable to fungal infection, based on the favourable results obtained, we consider that branched xenopericardial roll graft replacement using a multidisciplinary, staged approach may serve as a useful treatment option for aortic arch/arch graft infection. [ABSTRACT FROM AUTHOR]

A 59-year-old male underwent Bio-Bentall + total arch replacement with a frozen elephant trunk for acute type A aortic dissection before at another hospital. He was diagnosed as mediastinitis and previous graft infection, followed by wound closure with omental flap installation. However, the recurrent graft infection from the aortic root to the FET in the descending aorta was diagnosed by 18-fluorodeoxyglucose positron emission tomography. Redo modified Bio-Bentall procedure, total arch replacement, and descending aortic replacement for previous graft infection using anterolateral thoracotomy with partial sternotomy was successfully performed. Anterolateral thoracotomy with partial sternotomy provided not only the excellent exposure from the aortic root to the descending aorta but also sure myocardial protection with antegrade and selective delivery of cold crystalloid cardioplegia and stable brain protection with antegrade selective cerebral perfusion. The patient is doing well without recurrent of infection after 2 years of the operation. [ABSTRACT FROM AUTHOR]

We describe the case of a 68-year-old man who underwent ascending aortic replacement and thoracic endovascular aortic repair. Four years later, the patient developed neck pain on the right side and chest computed tomography showed expansion of fluid in the mediastinum which had extended to the neck. Echocardiography revealed advanced severity of aortic regurgitation and decreased ejection fraction. Given the progression of aortic regurgitation, decreased cardiac function, and rapidly expanding fluid accumulation causing neck pain, reoperation was indicated. All microbiological test including polymerase chain reaction were negative indicating absence of any infection. The patient is being followed-up without antibiotics and CT has not shown peri-graft fluid 2 years postoperatively. Since infection cannot be excluded completely, it is important to assess the condition with selective medium, extended culture periods, genetic testing, and consultations with microbiology laboratories when normal culture tests for general bacteria, and fungi are negative which can help avoid drug-resistant bacteria count, elevated medical costs, and drug side effects due to the improper use of antibiotics through proper diagnosis. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES The aim of this study was to analyse the indications, surgical extent and results of treatment, as well as determine the risk factors for adverse outcomes after redo arch surgery. METHODS Between January 1996 and December 2022, 120 patients underwent aortic arch reoperations after primary proximal aortic surgery. We retrospectively analysed perioperative data, as well as early and mid-term outcomes in these patients. RESULTS Indications for arch reintervention included new aortic aneurysm in 34 patients (28.3%), expanding post-dissection aneurysm in 36 (30.0%), aortic graft infection in 39 (32.5%) and new aortic dissection in 9 cases. Two patients underwent reoperation due to iatrogenic complications. Thirty-one patients (25.8%) had concomitant endocarditis. In-hospital and 30-day mortality rates were 11.7% and 15.0%, respectively. Stroke was observed in 11 (9.2%) and paraplegia in 1 patient. Prior surgery due to aneurysm [odds ratio 4.5; 95% confidence interval (CI) 1.4–17.3] and critical preoperative state (odds ratio 5.9; 95% CI 1.5–23.7) were independent predictors of 30-day mortality. Overall 1- and 5-year survival was 65.8 ± 8.8% and 51.2 ± 10.6%, respectively. Diabetes mellitus (hazard ratio 2.4; 95% CI 1.0–5.1) and peripheral arterial disease (hazard ratio 4.7; 95% CI 1.1–14.3) were independent predictors of late death. The cumulative incidence of reoperations was 12.6% (95% CI 6.7–20.4%) at 5 years. Accounting for mortality as a competing event, connective tissue disorders (subdistribution hazard ratio 4.5; 95% CI 1.6–15.7) and interval between primary and redo surgery (subdistribution hazard ratio 1.04; 95% CI 1.02–1.06) were independent predictors of reoperations after redo arch surgery. CONCLUSIONS Despite being technically demanding, aortic arch reoperations are feasible and can be performed with acceptable results. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cryopreserved allogeneic blood vessels have broad clinical application prospects in vascular transplantation and repair. Cryopreservation is a common method to achieve long-term preservation of allogeneic blood vessels. During cryopreservation, effective cryoprotectants are essential to prevent vascular tissue hypothermia damage and maintain cell viability. However, there is no consensus on the choice of the best cryoprotectant. OBJECTIVE: To summarize the cryoprotectants used in major vascular tissue banks in recent years and compare their clinical effects, thereby providing a reference for the application of cryopreservation of allogeneic blood vessels in the future. METHODS: The relevant literature included in CNKI, WanFang, PubMed, and Google Scholar databases from 2015 to 2022 was retrieved by the first author. The Chinese search terms were “allogeneic blood vessels, artery, vein, cryopreservation, cryoprotective agent, cryoinjury, vascular transplantation.” The English search terms were “cryopreservation, blood vessels, vascular allografts, arteries, veins, cryoinjury, cryoprotectants, cryoprotective agents.” The relevant literature at home and abroad on vascular cryoprotectants used in clinic and their short-term and long-term results were searched. Finally, 54 articles were selected for review. RESULTS AND CONCLUSION: (1) In the study of cryopreservation of blood vessels, a combination of permeable and non-permeable cryoprotectant is often used to reduce damage to the structure of the vessel wall through programmed cooling and rapid thawing. (2) Despite the toxic effects of dimethyl sulfoxide, tissue bank product lists in many countries do not include any cardiovascular tissue cryopreserved with cryoprotectant other than dimethyl sulfoxide alone. At present, there are still many clinical complications after cryopreservation of allogeneic blood vessels for vascular transplantation, and some are even fatal. (3) As an essential component of protective agent, dimethyl sulfoxide is very important to balance its toxic effect and protective effect. Finding a new type of cryoprotectant that is safe, non-toxic and free of xenogeneic antigens is the main direction of current research, which is very important for the clinical development of allogeneic vascular grafts. [ABSTRACT FROM AUTHOR]

The article in the World Journal of Surgery discusses the use of prophylactic muscle flaps in high-risk patients undergoing prosthetic bypasses involving the common femoral artery. The study found that while there was no significant difference in 30-day mortality or major adverse cardiovascular events, there was a higher rate of deep incisional infection in patients with muscle flaps. The authors suggest that the use of muscle flaps may increase the risk of wound complications, although the long-term impact on graft infection rates remains uncertain. The study highlights the importance of evaluating surgical interventions to ensure they do not inadvertently worsen the conditions they aim to prevent. [Extracted from the article]

Graft infections are associated with severe morbidity and mortality. The widespread use of the frozen elephant technique increases the incidence of complex aortic patients to suffer from graft infections. Surgery of these patients is challenging. Removal of the stent graft portion of the frozen elephant technique prosthesis via sternotomy carries the risk of irreparable damage to the descending aorta. There is currently no single-stage surgical strategy that allows for the removal of all infected material apart from a hemi-clamshell approach. This approach is technically demanding and associated with significant morbidity and mortality. This results in conservative treatment in a substantial number of patients. Pericardial tube grafts have shown to be an excellent option in treating graft infections in various aortic segments with promising results concerning freedom of re-infection and survival. We report a single-stage, trans-sternal approach to remove all infected materials and simultaneously treat the descending aorta to prevent aortic catastrophe in 2 consecutive cases. [ABSTRACT FROM AUTHOR]

Objective: Proximal aortic graft infection (PAGI) is a rare but often fatal postoperative complication. Its management often relied on surgical preferences and resource availability of each centre, until the recent unifying guidelines published by the European Society for Vascular Surgery (ESVS). This paper aimed to amalgamate the published experience in managing PAGI and their outcomes.Methods: PubMed, Scopus and Cochrane Library databases were searched systematically. All primary studies besides single-patient case reports were included. Data extracted included study and patient characteristics, type of index surgery, type of microorganisms involved, definitive treatment modality, and any outcome measures reported.Results: Of the 20 studies included, 157 of the 290 PAGI patients underwent complete graft explantation and replacement, 106 underwent graft-preservation interventions (debridement and/or irrigation), and 25 had antibiotics alone. Adjunctive interventions included graft coverage, vacuum-assisted closure, use of infection-resistant graft materials, and lifelong suppressive therapy. In-hospital mortality was 20.8% (n=60), with postoperative sepsis and multiorgan failure (n=24) being the most common cause. Recurrent infection occurred in 10 post-discharge patients. Post-discharge mortality rate was 11.4% (n=33), with cardiac complications and stroke being the most common cause in surgically-treated and medically-treated patients, respectively.Conclusions: Given the risk of mortality, the management approach of PAGI highly depends on the fitness of the patient. We believe that early referral to specialised aortic centres is essential to plan for optimal management strategies and improve patient outcomes. Further studies are also required to parse out the most effective adjunctive interventions to maximise patient outcomes. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES Our aim was to evaluate the mid-term outcomes of bovine pericardial tube graft repair for infectious aortic disease in any aortic segment. METHODS Between May 2015 and July 2020, 45 patients were treated for infectious aortic disease of the native (n  = 9) aorta or after (endo-)graft (n  = 36) implantation with bovine pericardial tube grafts. Clinical, infectious details, outcomes and follow-up data were evaluated. RESULTS All aortic segments underwent pericardial tube graft or bifurcational replacement: the aortic root (n  = 12, 27%), ascending aorta (n  = 18, 40%), aortic arch (n  = 7, 16%), descending aorta (n  = 5, 11%), thoraco-abdominal aorta (n  = 6, 13%) and abdominal aorta (n  = 18, 40%) including the iliac arteries (n  = 14, 31%). Organ fistulation (n  = 15, 33%) was the most common underlying pathology. Seven patients (16%) expired in-hospital secondary to ongoing sepsis (n  = 5, 11%), respiratory failure (n  = 1, 2%) and unknown cause (n  = 1, 2%). A fungal infection was predictive for in-hospital mortality (P  = 0.026, odds ratio: 19.470). After a median follow-up of 11 [first quartile: 2, third quartile 26] months, 9 additional patients (20%) expired and 1 patient developed a postoperative spondylodiscitis at the level of the aortic tube graft. Hence, freedom from proven aortic graft re-infection was 98%. CONCLUSIONS Orthotopic aortic reconstruction using bovine pericardial tube grafts to treat infectious aortic disease is possible in any aortic segment. Organ fistulation is a frequently observed disease mechanism requiring concomitant treatment. Granted, the early attrition rate is substantial, but after the initial period, both survival and freedom from re-infection appear encouraging. [ABSTRACT FROM AUTHOR]

Vibrio metschnikovii is a widespread opportunistic pathogen that rarely causes disease in human. It caused graft infection in our case. It is important to differentiate it from another water‐transmitted pathogens. [ABSTRACT FROM AUTHOR]

Introduction: Surgical site infection (SSI) presents a ubiquitous concern to surgical specialties, especially in the presence of prosthetic material. Antibiotic-impregnated beads present a novel and evolving means to combat this condition. This review aims to analyze the quality of evidence and methods of antibiotic bead use, particularly for application within vascular surgery. Methods: A systematic scoping review was conducted within Embase, MEDLINE, and the Cochrane Registry of Randomized Controlled Trials. Articles were evaluated by 2 independent reviewers. Level of evidence was evaluated using the Oxford Center for Evidence-Based Medicine Criteria and the Cochrane Risk of Bias Tool for Randomized Controlled Trials. Results: The search yielded 6951 papers, with 275 included for final analysis. Publications increased in frequency from 1978 to the present. The most common formulation was polymethyl methacrylate; however publications on biodegradable formulations, including calcium sulfate beads, have been published with increasing frequency. Most publications had positive conclusions (94.2%); however, the data was mainly subjective and may be prone to publication bias. Only 11 randomized controlled trials were identified and all but one was evaluated to be at a high risk of bias. The most common indication was for osteomyelitis (52%), orthopedic prosthetic infections (20%), and trauma (9%). Within vascular surgery, beads have been used primarily for the treatment of graft infection, with freedom from recurrence rates being reported from 41% to 87.5%. Conclusions: Antibiotic-impregnated beads provide a means to deliver high doses of antibiotic directly to a surgical site, without the risks of parenteral therapy. There has yet to be significant high-level quality data published on their use. There is a large body of evidence that suggests antibiotic beads may be used in SSIs in high-risk patients, prosthetic infections, and other complex surgical infections. Important potential areas of application in vascular surgery include graft infection, prevention of wound infection in high-risk patients, and diabetic foot infection. [ABSTRACT FROM AUTHOR]

Prosthetic vascular graft infection is one of the most severe vascular surgery complications. Fibrin gel (FG) has many useful characteristics as biocompatibility, biodegradation, adhesion, and haemostasis to develop the local antibiotic delivery system. In this study, human plasma was collected from peripheral blood that was used to create fibrin gel by supplement ion Ca2+. Antibiotic-containing fibrin gel was then evaluated in some characteristics such as surface structure, biodegradation, antibiotic delivery, cytotoxicity, and bacterial biofilm prevention in vitro and in vivo. The results showed that fibrin gel was excellent material for the extended delivery of antibiotics. Most importantly, antibiotic-containing fibrin gel was not toxic for human fibroblast cells in vitro and inhibited bacterial biofilm growth in vitro and in vivo. This research is the first step in developing an antibiotic delivery system for effective graft infection treatments. [ABSTRACT FROM AUTHOR]

Abdominal aortic graft infections (AGIs) occur in 1–5% of aortic prosthetic placements. It can result in limb amputation, pseudo-aneurysm formation, septic emboli, aorto-enteric fistulae, septic shock and death. The most frequently involved pathogens are methicillin-susceptible Staphylococcus aureus , methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci, followed by Enterobacteriaceae and uncommon bacteria. In case of gut involvement the presence of fungi has to be considered. Computed tomography angiography is actually the gold standard diagnostic imaging but magnetic resonance is a valid alternative. Nuclear medicine imaging is commonly used to improve sensitivity and specificity. Signs and symptoms are often aspecific and blood cultures can be negative, requiring alternative ways to detect the microorganism responsible for infection, such as 16S rRNA gene sequencing and molecular rapid diagnostic tests. Curative surgical intervention is the first choice approach, with in-situ reconstruction providing by far the best outcome and xenopericardial bovine patch as a promising option. For patients unable to undergo major surgery, the outcome of conservative approach remains uncertain but usually provides for life-long suppressive therapy. However, in selected cases an attempt of stopping antibiotic treatment after 3–6 months can be done. Given the difficulty in their management, we performed a review of AGIs, in order to raise awareness on clinical presentation, current available diagnostic tools, prophylaxis, surgical and anti-infective treatment of AGIs. [ABSTRACT FROM AUTHOR]

The purpose of this study is to introduce the aortic bulge sign, a finding observed retrospectively on computed tomography prior to the acute presentation of aortoenteric fistula, and to determine its interobserver reliability. Following research ethics board approval, all cases of aortoenteric fistula at our institution occurring from 2011–2015 were identified retrospectively. All previous computed tomography images of patients who eventually developed aortoenteric fistula were reviewed by a single observer for the presence of a potentially predictive finding of fistulization, the aortic bulge sign. These previous images were then combined with age and sex matched controls into a case bank. Eight radiology residents and staff were instructed in observing the aortic bulge sign. These observers then reviewed the case bank in a blinded analysis to determine the interobserver reliability of this finding. Fourteen cases of aortoenteric were identified. The average patient age was 70.71 years with a male-to-female ratio of 11:3. Eleven patients had previous computed tomography images available for review. With blinded analysis by multiple observers, the aortic bulge sign was identified with greater than 80% agreement in six of 11 cases (66.67%). Fleiss' kappa was calculated at k = 0.60 (95% confidence interval 0.50–0.69), corresponding to moderate-to-substantial interobserver agreement. The aortic bulge sign has been retrospectively identified as a promising computed tomography finding of eventual aortoenteric fistula prior to acute presentation. Further study is required to determine the diagnostic value of this sign. [ABSTRACT FROM AUTHOR]

In this study, we report a unique case of aorto-bifemoral graft infection, which developed in a 47-year-old male patient after endovascular aortic aneurysmal repair (EVAR) and extra anatomic axillo-femoral bypass. The patient had previously been treated by EVAR for an infrarenal abdominal aortic aneurysm. Earlier, the EVAR was blocked by a thrombosis and treated with an extra-anatomic axillo femoral bypass, which then became occluded. The patient was then treated with an aorto-bifemoral bypass using a Dacron Y graft. A few months later, he was referred to our cardiovascular center with high body temperature, weight loss, inability to stand and walk, and very serious sepsis. A computed abdominal tomography scan revealed that a part of the graft proximal to the bifurcation had totally eroded into the proximal jejunum. We treated this patient with multiple surgeries, antibiotic administrations and hypochlorous acid irrigation without graft excision, which carries a high morbidity and mortality risks. [ABSTRACT FROM AUTHOR]

Background: Primary infection of the abdominal aorta is a rare pathology that may threaten the integrity of the aortic wall, while secondary aortic prosthesis infection represents a devastating complication to open surgical and endovascular aortic surgery. Curative treatment is achievable by removal of all infected prosthetic material followed by a vascular reconstruction. Design and Methods: Twelve consecutive patients treated with the neo-aortoiliac system bypass (NAIS) procedure were reviewed. Nine were treated for a secondary aortic prosthesis infection (tube graft n = 3, bifurcated graft n = 4, endovascular aortic repair (EVAR) stent graft n = 1, and fenestrated EVAR [FEVAR] stent graft n = 1), while 3 patients underwent NAIS repair due to an emergent primary mycotic aortoiliac aneurysm. Primary Results: Ten of 12 patients survived 30 days. Three patients were operated on acutely, and 9 patients had elective or subacute NAIS surgery. Two of 3 patients operated acutely died within 30 days, whereas no 30-day or 1-year mortality was observed in patients undergoing elective or subacute surgery. The median time from primary reconstruction to the NAIS procedure was 11 months (range: 0-201 months). Stent grafts (n = 5 of 12) were in 4 cases explanted using endovascular balloon clamping. Of the explanted endografts, 2 patients presented with a secondary graft infection after EVAR/FEVAR, while 3 patients had been emergently treated with endovascular cuffs as a "bridge-to-surgery" procedure due to aortoenteric fistula (AEF). Patients who received a "bridge-to-surgery" regimen were treated with the NAIS procedure within 8 weeks (median 27 days, range: 27-60) after receiving emergency stent grafting. Principal Conclusions: Aortic balloon-clamping during explantation of infected aortic prosthetic endografts is feasible and facilitates complete endograft removal. Endovascular bridging procedures could be beneficiary in the treatment of AEF or anastomotic dehiscence due to graft infection, offering a possibility to convert the acute setting to an elective definitive reconstructive procedure with a higher overall success rate. [ABSTRACT FROM AUTHOR]

Although intravesical therapy with bacillus Calmette-Guérin (BCG) has proven its efficiency in the treatment of early-stage bladder cancer, infectious complications can occur and mycotic aneurysms represent a rare but life-threatening complication. Here, we report the case of an aortic graft infection in a patient with abdominal aortic aneurysm who received BCG instillations for the treatment of bladder cancer. Based on the current knowledge on this rare vascular complication, we discuss factors that may have contributed to its occurrence and review issues to optimize its management and early detection. [ABSTRACT FROM AUTHOR]

Infections of grafts used in vascular surgery, despite both surgical and medical measures, are an important problem that causes serious problems for the patient and the physician. Difficulties in diagnosing and planning treatment make this situation more complicated. Considering the serious consequences of this clinical picture, the patient should be evaluated well. After the diagnosis is confirmed, the excision of the graft with a serious antibiotherapy and the need to restore the revascularization, if necessary, may vary depending on the clinical picture. The aim of this article is to share our treatment strategy in a patient with recurrent graft occlusion and an infected graft. [ABSTRACT FROM AUTHOR]

Which graft material is the optimal graft material for the treatment of aortic graft infections is still a matter of controversy. We used a branched xenopericardial roll graft to replace an infected aortic arch graft as a "rescue" operation. The patient is alive and well 37 months postoperatively without recurrence of the infection and any surgical complication. This procedure may have the possibility to serve as an option for the treatment of aortic arch graft infection. [ABSTRACT FROM AUTHOR]

Aims: Prosthetic graft infection frequently requires graft replacement. Among other options, a biological graft could serve as an alternative choice. Decellularization reduces tissue immunogenicity. Our aim was to determine an efficient decellularization method and to evaluate the decellularized porcine biografts' adaptability. Methods: Four different protocols were implemented to decellularize porcine aortic segments (n = 4). Cell removal effectiveness and matrix structure preservation were histologically examined. Mechanical tests were performed. Decellularized porcine grafts were interpositioned in a porcine aorta. After a 6-month period, implanted samples were removed and evaluated using light and electron microscopy. Results: Histological results showed complete removal of cells and preserved connective tissue fiber structure following decellularization, using sodium dodecyl sulfate and sodium azide. Pressure tests demonstrated similar compliance to fresh vessels. In 9 out of 10 cases, pigs survived the follow-up period. Graft rejection, intimal hyperplasia, reocclusion and/or aneurysm formation were not observed. Presence of host cells and neoendothelialization were microscopically confirmed. Conclusions: This decellularization protocol enables a cost-effective preparation of biological grafts featuring reduced immunogenicity. The implanted grafts did not degenerate during the 6-month follow-up period, the lack of graft rejection suggests acceptable immunological tolerance, while recipient cells migrate into, proliferate and differentiate, thus creating the possibility for further use as an optional vascular graft. [ABSTRACT FROM AUTHOR]

Abstract: Microsporidia are intracellular organisms most commonly known to cause opportunistic infection in patients with human immunodeficiency virus (HIV). There have been several case reports of infection in solid organ and bone marrow transplant recipients. Here, we report a case of a non‐HIV–infected renal transplant patient with microsporidiosis of the renal tract associated with acute graft dysfunction. We also review the literature of 12 previously reported cases of microsporidiosis in patients with renal transplants who had described graft involvement. We review the pattern of illness as well as the common renal biopsy features when microsporidial infection is associated with renal graft infection. [ABSTRACT FROM AUTHOR]

Background: Surgical site infections (SSIs) constitute one of many major complications after aortic aneurysm surgery and its details and outcome have not been evaluated extensively. This research evaluates the incidence and outcome of SSI and graft infection in open and endovascular abdominal aortic aneurysm surgery.Patients and Methods: A retrospective study was performed, including all patients who underwent surgery for aortoiliac aneurysmatic disease between January 2000 and December 2016 in the Amphia Hospital, Breda, The Netherlands. Surgical site infections were defined in accordance with criteria of the U.S. Centers for Disease Control and Prevention (CDC). Aortic graft infection was diagnosed by a combination of computed tomography imaging and microbiologic results.Results: Between January 2000 and December 2016, 845 patients (mean age, 72.80 ± 7.15 y, 86.3% male) underwent abdominal aneurysm surgery (477 endovascular, 368 open). The total SSI rate was 3.1% (12 endovascular [2.5%], 14 open [3.8%], p = 0.318) with 0.8% deep SSI (26.9% of SSIs). No difference in SSIs was found between acute and elective surgery (2.9% vs. 3.1%, p = 1.000). Patients with SSI had a longer duration of stay (mean, 27.65 ± 30.74 d vs. 9.79 ± 12.50 d, p < 0.0001) but no difference in 30-day or 1-year mortality. Twenty-four graft infections occurred (4.3% of open vs. 1.7% of endovascular surgery, p = 0.023) of which 20 (83.3%) required surgery. Two-year mortality was higher when graft infections occurred (33.3% vs. 16.3%, p = 0.046). Surgical site infections (odds ratio [OR] 7.10, 95% [CI] 2.10-23.98) and mycotic aneurysms (OR 9.38, 95% CI 1.78-54.19) are independent determinants for graft infections.Conclusion: This study shows that SSIs after endovascular aortic surgery are as common as after open aortic surgery. Furthermore, this study supports the concept that aortic graft infection is highly associated with SSIs and mycotic aneurysms. Studies evaluating the prevention or early diagnosis of graft infection after SSIs through intensified imaging follow-up or even long-term antibiotic treatment should be considered. [ABSTRACT FROM AUTHOR]

The potent immunosuppressive drugs used by transplant recipients place them at risk of infections. Data on infective endocarditis ( IE) in the setting of renal transplantation ( RT) are sparse. We describe a 36-year-old woman referred to a tertiary medical center for evaluation of elevated creatinine levels 1 month after a second RT. Work-up revealed the presence of all four of Duke's criteria: fever, persistent bacteremia, new-onset tricuspid regurgitation, and masses suspected to be vegetation attached to the tricuspid annulus. Symptoms resolved with antibiotic treatment and fluids. Fluorodeoxyglucose-positron emission tomography/computed tomography ( FDG- PET/ CT) revealed hypermetabolic absorption in the femoral vascular graft that had been used for hemodialysis prior to transplantation. The graft was removed by open surgery, and the patient was discharged home in good condition with continued antibiotic treatment. Review of the literature yielded 73 previously reported cases of IE in renal transplant recipients. Several differences were noted from IE in the general population: lower male predominance, younger age (<60 years), absence in most cases of a preexisting structural cardiac anomaly, and more variable causative pathogens. Our case also highlights the importance of FDG- PET/ CT for detecting the source of IE and alerts clinicians to the sometimes unexpected course of the disease in renal transplant recipients. [ABSTRACT FROM AUTHOR]

Background: Aortic graft infections (AGI) are rare, with an incidence of 0.6%-3% among patients with aortic grafts. Most previous reports are based on single-center material with limited follow-up. Because of the paucity of these cases, the optimal treatment remains unclear. A factor possibly affecting the mortality rate of these infections is whether the index procedure was emergency or elective. The aim of this study was to investigate the incidence of AGI and assess the long-term outcome after emergency and non-emergency aortic reconstruction in a large population.Method: A population-based, retrospective study was conducted of all patients treated with aortic reconstructive surgery at the two centers for vascular surgery in Stockholm County (population 2.2 million) during 2005-2015. Patients with AGI were identified by the in-hospital patient registry. Chart data on demographics, co-morbidity, index operation, type of infection, treatment, and outcome were analyzed.Results: Reconstructive aortic surgery was performed on 2,026 patients (open repair 47.7%; endovascular aortic repair 52.3%). The incidence of infection was 1.4% (29/2,026). The index operation was performed as an emergency in ten patients and non-emergency in 19. Median follow-up after the index operation was 69.2 months (interquartile range [IQR] 109.5). Patients having an emergency index procedure were older (77 vs. 69 y; p = 0.03). Time to infection was similar (30.2 ± 27.4 and 56.1 ± 51.2 mos; p = 0.21). The median time from diagnosis of AGI to surgery was 30 d (IQR 30.5 d). Infectious agents were identified in 76% of the cases. Of the conservatively treated patients, one was free of infection compared with three of the surgically treated. Conservatively treated patients had a higher graft-associated mortality rate of 57% compared with 25% of the surgically treated (p = 0.05).Conclusions: This population-based study with long-term follow-up confirms the low incidence of AGI, 1.4%. The similar incidence in the emergency and non-emergency groups suggests that the index operation is not decisive in the development of AGI. The outcome of these infections generally is poor but is worse for non-surgically treated patients. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Treatment of infected thoracic aortic grafts is associated with considerable morbidity and mortality. The replacement of an infected graft is an effective strategy, yet a complex surgical endeavour, especially if the aortic root or aortic arch is involved. In situ graftsparing surgical therapy with continuous mediastinal irrigation after surgical debridement might offer an alternative in the management of early graft infections in the thoracic aorta. METHODS: Between 1996 and August 2015, 25 patients were treated in our institution for early graft infection after thoracic aortic surgery via sternotomy. In 11 patients, the infected prosthesis was replaced by a cryopreserved homograft or a biological valved pericardial xenograft. In 14 patients, an attempt to salvage the graft was made by resternotomy, aggressive debridement and subsequent continuous mediastinal antibiotic irrigation over a course of 2 weeks, accompanied by systemic antibiotic therapy. RESULTS: In-hospital mortality was comparable (replacement group: 2/11 = 18%, graft-sparing group: 2/14 = 14%, P = ns). The time interval from the initial surgery was significantly shorter in the graft-sparing group (replacement group: 165 days [range 95-300 days] and graftsparing group: 24 days [range 15-93 days], P = 0.004]. Two patients (14%), who were treated with the graft-sparing approach >100 days after the initial surgery, were retreated for infection, and 1 due to an intra-aortic infection of an aortic arch hybrid stent graft was not amenable to external irrigation (median follow-up: 1.5 years [range 1.1-2.1 years]). One patient in the replacement group (9%) was reoperated on due to homograft degeneration (median follow-up: 6.0 years [3.0-8.9 years]). CONCLUSIONS: In situ graft-sparing surgical therapy is safe and effective if diagnosis and treatment of aortic graft infection is initiated promptly and aggressively (ideally <1 month post-surgery). Our method produces good midterm results (3 years). For aortic graft infections that become clinically apparent >3-6 months after surgery, replacement of grafts with biological conduits (homografts or pericardial xenografts) most likely remains the best treatment option. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to determine whether polytetrafluoroethylene grafts or Omniflow II biosynthetic grafts are more resistant to infection caused by Staphylococcus aureus. Methods: Sixty rats were divided into six groups. In Groups 1A, 1B and 1C, a polytetrafluoroethylene graft was implanted in each rat, and, in Groups 2A, 2B and 2C, a biosynthetic graft was implanted in each rat. Staphylococcus aureus was inoculated into Groups 1B, 1C, 2B and 2C, and the rats in Groups 1C and 2C were treated with teicoplanin. One week later, the rats were euthanized, the grafts were removed and a microbiological count was performed. A histopathological examination was subsequently carried out, and the C-reactive protein, prealbumin and leukocyte levels were investigated. Results: There were no significant differences in the C-reactive protein, prealbumin and leukocyte levels. The differences in the results of the microbiological evaluations between the groups were significant. The quantitative culture results showed no bacterial growth in Groups 1A, 1C and 2A. The number of bacteria in Group 1B was statistically lower than that in Group 2B. When the groups receiving treatment were compared, Group 2C had bacterial growth, whereas Group 1C did not. The histopathological examinations showed similar results. Conclusions: Omniflow II grafts are more susceptible to infection than polytetrafluoroethylene grafts. [ABSTRACT FROM AUTHOR]

Background: Which graft material is the optimal graft material for the treatment of infected aortic aneurysms and aortic graft infections is still a matter of controversy. Orthotopic aortic reconstruction with intraoperatively prepared xenopericardial roll grafts without omentopexy was performed as the "initial" operation to treat aortic infection or as a "rescue" operation to treat graft infection. Mid-term outcomes were evaluated.Methods: Between 2009 and 2013, orthotopic xenopericardial roll graft replacement was performed to treat eight patients (male/female: 6/2; mean age: 69.5 [55-80] yr). Graft material: equine/bovine pericardium: 2/6; type of operation: initial 4/rescue 4; omentopexy 0. Additional operation: esophagectomy 2. Mean follow-up period: 2.6 ± 1.6 (1.1-5.1) years.Results: Replacement: ascending 3, arch 1 (reconstruction of neck vessels with small xenopericardial roll grafts), descending 3, and thoracoabdominal 1. Pathogens: MRSA 2, MSSA 1, Candida 1, E. coli 1, oral bacillus 1, and culture negative 2. Postoperative local recurrence of infection: 0. Graft-related complications: stenosis 0, calcification 0, non-infectious pseudoaneurysm of anastomosis 2 (surgical repair: 1/TEVAR 1). In-hospital mortality: 2 (MOF: initial 1/rescue 1); Survival rate exclusive of in-hospital deaths (~3 y): 100 %, but one patient died of lung cancer (3.6 yr).Conclusions: Because xenopericardial roll grafts are not composed of synthetic material, the replacement procedure is simpler and less invasive than the standard procedure. Based on the favorable results obtained, this procedure may have the possibility to serve as an option for the treatment of aortic infections and aortic graft infections not only as a "rescue" treatment but as an "initial" treatment as well. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the process of bacterial invasion from the surface to inside prosthetic vascular grafts. Methods: Elastomer-sealed Dacron vascular grafts (ESDVGs) and gelatin-coated Dacron vascular grafts (GCDVGs) were cut into 6-cm segments and placed in a U-shaped configuration on culture plates. Physiological saline was poured inside the grafts and a suspension of Pseudomonas aeruginosa was added to the outside. Samples taken from inside the grafts at nine time points for up to 60 h were spread on agar. Bacterial colonies were then analyzed. The grafts were also examined using scanning electron microscopy (SEM). Results: Contaminated vascular graft models were produced in 18 ESDVGs (group T) and 12 GCDVGs (group G). The bacterial counts inside the vascular grafts in both groups increased over time. Bacterial colonies were confirmed in all samples from group G by 30 h, whereas bacteria appeared inside the grafts from group T at various times between 0 and 60 h. Bacteria were undetectable in one model from group T throughout the study. SEM revealed that the elastomeric membrane in the ESDVG was uneven. Conclusion: Bacterial invasion of vascular grafts does not always occur immediately after contamination. ESDVGs may be more resistant to bacterial invasion as they have a thicker and evenly enriched elastomeric membrane. [ABSTRACT FROM AUTHOR]

Diagnosis of vascular graft prosthesis infection is crucial, but not straightforward. Here we report two cases in which [18 F] fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18 F-FDG PET/CT) was very useful in the diagnosis of aortic graft infection. Case 1: A 77-year-old Japanese man, two months status post aortic arch graft surgery, suffered from repeated fevers. Blood cultures revealed bacteremia. 18 F-FDGPET/ CT ruled out graft infection and diagnosed lumbar pyogenic spondylitis, which was treated with antibiotics, sparing the patient a possible reoperation. Case 2: A 53-year-old Japanese man, seven years status post replacement of the aortic root and ascending aorta, had been suffering from an ostensibly aseptic fistula for over a year and a half. Although repeated CT findings had been negative, 18 F-FDG-PET/CT clearly demonstrated communication between the fistula and the ascending aortic graft. He was treated with repeat ascending aortic replacement, omentopexy, and antibiotics. Our experience supports 18 F-FDG-PET/CT as a promising modality in cases of suspected vascular graft infection. [ABSTRACT FROM AUTHOR]

OBJECTIVES The management of infected Dacron grafts in the ascending aortic position involving the aortic arch and aortic root remains a technical challenge. Total replacement of the infected graft material with cryopreserved homografts appears to be an effective treatment strategy for these patients. METHODS Seventeen consecutive patients were operated on for infection of their ascending aortic graft where the aortic arch was also involved 26 ± 33 months after initial surgery, in 70%, for type A aortic dissection (12 acute aortic dissection type A and 1 chronic aortic dissection type A). The aortic root was additionally affected in 14 patients. Computed tomography and echocardiography follow-up was performed in all patients. RESULTS Hospital mortality was 24% (n = 4). Cardiopulmonary bypass and aortic cross-clamp times were 288 ± 128 and 165 ± 78 min, respectively. In 14 patients, the aortic root was replaced. Hypothermic circulatory arrest was necessary in all patients (41 ± 25 min) with additional cold selective antegrade cerebral perfusion in 14 (41 ± 30 min). During follow-up, 1 patient died due to a cerebral haemorrhage at 3 months and another at 4 years, of pulmonary embolism. Two patients were successfully reoperated on for degeneration of the aortic valve at 16 and 94 months; 1 patient had an early degeneration of the homograft and needed re-replacement with a homograft. In 2 other patients, a stent graft had to be placed to cover the distal anastomosis between the homograft and native aorta. In all others, recent follow-up revealed no degeneration of the implanted homografts. CONCLUSIONS Surgery for infected Dacron grafts in the ascending aortic position with involvement of the arch can be performed with an acceptable perioperative mortality. In case of degeneration of the valve, reoperations can be performed with good results in experienced hands. Therefore, we consider the concept of complete explantation of all infected material and replacement with homografts a successful treatment strategy. Nevertheless, close follow-up of the patients is mandatory so as not to miss any degeneration or reinfection of the implanted grafts. [ABSTRACT FROM PUBLISHER]

We report a case of 74-year-old man presenting with a rupture of a thoracic aortic false aneurysm after undergoing conventional total arch replacement for aortic arch aneurysm (62 mm) and endovascular stent placement for descending aortic aneurysm (70 mm). His chief complaints at the present admission were fever and sensation of dyspnea and we put him on a course of antibiotics for stent graft infection. However he died of massive hemoptysis. From a standpoint of autopsy findings, a thoracic aortic false aneurysm formed at the just proximal landing zone owing to type Ia endoleak, and simultaneously stent graft infection lead to make fistula formation between the false aneurysm and the lung. We examined ourselves that stent graft infection and aortopulmonary fistula caused by an infected thoracic aortic false aneurysm rupturing into the lung should be promptly treated such as complete removal of the stent and another revascularization in a reasonable period of time except if there are complications such as comorbid1ities or withholding of consent. We experienced and reported one rare case associated with a rupture of thoracic aortic false an. [ABSTRACT FROM AUTHOR]

Aortoenteric fistula is a devastating complication of aortic aneurysm repair. Traditional repair carries a high risk of mortality and significant morbidity.While endograft repair can be effective at mitigating the immediate life-threatening bleed, the temptation to consider endograft repair as definitive treatment should be resisted. We present a case of a 72 year old male who developed an aortoenteric fistula four years following surgical repair of a ruptured aortic aneurysm. Four years thereafter the patient developed infection of the graft and required extra-anatomic bypass and excision of the infected graft. Endograft repair of aortoenteric fistula is associated with persistent infection and should be viewed as a temporizing measure. Here we present the case and review the literature regarding the treatment and outcome of this condition. [ABSTRACT FROM AUTHOR]

Abstract: The use of mesh in hernia repair has become common, because of lower recurrence rate and simple application. Data from the meta-analysis and the multi-central studies support the use of meshes in hernia repair. One of the complications due to the hernia repair with mesh is the infection. The incidence range is between 1 and 10%. Triclosan embedded commercial absorbable suture materials are used to reduce surgical site infection rate. This study was planned on mesh infection model, because of the low incidence rate. The agent isolated from mesh infections was mostly Staphylococcus aureus and thus it was used as the infecting agent in this research. To achieve a better therapeutic efficacy, triclosan was formulated in chitosan gels. Chitosan is an attractive biopolymer because of its biocompatible, biodegradable, bioadhesive properties. Gel formulations using chitosans (low, medium and high molecular weight) were prepared in 1% (v/v) acetic acid solution and in vitro release profiles were evaluated. Gel formulations showed release profile extended up to 7 days and high molecular weight chitosan gel formulation was released higher quantity drug than other formulations. Meshes coated with triclosan loaded chitosan gel were used to reduce bacterial count and to prevent mesh infection in the study. 24h and simultaneous bacteria inoculation was used to model mesh infection. The rats were observed for 8 days by means of surgical site infection. On the eighth day, the animals were sacrificed and the grafts were removed. Tissue squeezers were used to liberate bacterias from removed grafts. The isolated suspensions were cultured on blood agar plates and colony-forming units were counted overnight. Grafts coated with triclosan loaded chitosan gel presented satisfactory preventive effect against graft infection. [Copyright &y& Elsevier]

Fresh autologous vein grafts are commonly used for infrainguinal vascular reconstructions with good results. Previously we have confirmed the high viability index of homografts even after long-term storage at 4°C in tissue culture medium. In this clinical study, we have evaluated the in vivo efficiency of this storage method in humans with major peripheral graft infections. Between April 2006 and November 2008, data from patients who underwent graft excision and venous allograft reconstruction were collected prospectively (5 men, 2 women, mean age 68 years). Six patients had acute ischemia at the time of allograft reconstruction, while 3 had experienced anastomosis rupture. Allograft reconstruction was performed as an emergency procedure in 3 cases. The observed parameters included patient survival, limb salvage, persistence or recurrence of infection and allograft patency. In the follow-up period reoperation, excision or thrombectomy was necessary in 3 cases. There were no perioperative deaths, early amputations, persistent or recurrent infections. In conclusion, this study demonstrates the efficacy of long-term 4°C storage of venous allografts for revascularization in cases with peripheral bypass graft infection. We suggest that this technique is a useful option for graft preservation and propose a wide-scale introduction. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

One of the most feared complications following vascular reconstruction is infection due to the attendant risks of limb loss, sepsis, or death. The reported incidence of infection following infrainguinal prosthetic graft infection is 2.5% with associated mortality rates and amputation rates of 18% and 41%, respectively. There are several options in treating infected prosthetic infrainguinal bypass grafts. Some authors have advocated complete removal of the infected graft with concomitant in situ revascularization using autogenous tissue or extra-anatomic bypass using either autogenous or prosthetic material, depending upon the clinical circumstances. Other authors have advocated attempting graft preservation to decrease the risk of amputation. Infected, thrombosed grafts are generally treated with graft excision alone with care taken to preserve collateral flow. The treatment options may also be influenced by the type of infection, as infections caused by gram-negative bacteria are thought to be more virulent than those associated with gram-positive bacteria. We recently treated a patient with an 18-month history of an exposed prosthetic graft in the groin, which was infected by Proteus mirabilis. Despite the extended period of graft exposure and despite gram-negative bacteria being the causative organism, the patient reported only intermittent drainage of pus from the groin. The management of this unusual infection forms the basis of this report. [ABSTRACT FROM AUTHOR]

Isolated groin infection following crossover femoral bypass is not uncommon, and its management may be challenging, especially in medically high-risk patients. When an in situ replacement is appropriate, using an autologous vein (femoral or saphenous) would be the pre- ferred method; however, this may not always be feasible. The authors used cryopreserved femoral vein grafts for in situ replacement of femorofemoral bypass grafts with excellent results in 3 high-risk patients who developed early graft infections and failed graft preservation attempts. In situ replacement of infected femorofemoral grafts using a cryopreserved femoral vein graft can be considered as a second-line intervention when an adequately sized autologous vein is unavailable or unusable or is not feasible in high-risk patients. [ABSTRACT FROM AUTHOR]

Background. Vascular prosthesis infection is one of the most severe complications in vascular surgery and is connected with high risk of limb amputation or death. The most common method of treatment is the total removal of the infected prosthesis and at the same time reconstruction of blood vessels using extra-anatomical or allogenic vascular grafts. The extent of these operations makes them of high risk in patients in severe general condition. Due to this problem there is a limitation in operation extent on behalf of local therapy The aim of this work was to analyze the result of local surgical treatment of vascular graft limited infections. Material and methods. In the years 1996-2003 sixty-four patients with prosthetic infection were treated by local therapy or partial removal of the graft. Results. During the observation period, 5% of the patients died and in 7.5% limb amputation was necessary. 92.4% of the patients were primarily cured of their infection but at follow up only 38.7% patients had healed satisfactorily without symptoms of reinfection. Symptoms of reinfection appeared in 53.7% patients within 1-36 months. The infection symptoms recurrence was observed most seldom in patients group after partial removal of the prosthesis without blood vessel reconstruction. Despite 5 cases of the recurrence limited to the grain responding to local therapy techniques, all other cases resulted in the progress of infection. Conclusions. Local treatment conies a high risk of reinfection, and should only be used for culture-negative grafts or in individuals who do not accept more radical treatment. Irrespective of the treatment method used the patients should be kept under regular clinical and radiological review for the early detection of reinfection diagnosis and the application of a more radical treatment approach. [ABSTRACT FROM AUTHOR]

Purpose: To describe the findings on computed tomography (CT) of the aortic sac (AS) in patients operated on for abdominal aortic aneurysm (AAA) with insertion of a coated Dacron prosthesis. Material and Methods: A prospective study of 36 consecutive patients operated on for AAA over 2 years and followed longitudinally with CT for up to 10 years. Results: All patients had a fluid-filled AS on CT 7-10 days postoperatively. At 6 months, the AS had decreased in most patients, mainly in the antero-posterior diameter, and in two had disappeared completely. In five patients with complications, the AS increased in size. The AS disappeared completely at 10 years' follow-up in 13 patients. When present, a retroperitoneal hematoma always disappeared after 6 months. Conclusion: These data indicate that the AS after graft implantation will diminish gradually but will persist for at least 6 months. Usually the transverse diameter is bigger than the antero-posterior diameter. If the AS enlarges and becomes rounded and distended with an inhomogeneous interior, it might be a sign of graft infection. In these cases an ultrasound-guided or CT-guided puncture is recommended. [ABSTRACT FROM AUTHOR]

Despite improvements in surgical techniques and antimicrobial therapies, prosthetic aortic graft infections remain a clinical problem. It is well known that chitosan has strong antibacterial activities to a wide variety of bacteria including Staphylococcus aureus, epidermidis and Escherichia coli (E. coli). The antibacterial activity by adhering a photocrosslinkable chitosan hydrogel to Dacron grafts was investigated in vitro and in vivo using a rabbit model.The photocrosslinkable chitosan hydrogel (50μl) coated grafts (3 × 2mm fragments) were evaluated on a resistance against E. coliin vitro. The graft infections in vivo were also initiated through implantation of a Dacron graft fragment into the infrarenal aorta of a rabbit, followed by a topical inoculation with 106 colony-forming units of E. coli. The graft infection was allowed to develop over the following 1 week.The photocrosslinkable chitosan hydrogel-coated grafts exhibited a resistance against E. coliin vitro. Furthermore, application of 0.1ml photocrosslinkable chitosan hydrogel on the Dacron implant in vivo substantially inhibited graft infection with E. coli.These preliminary results suggested the potential use of a photocrosslinkable chitosan hydrogel in directing graft infection prophylaxis. [Copyright &y& Elsevier]

Purpose. The study was conducted to compare the results of two different techniques of vascular reconstruction in patients after the removal of infected vascular prostheses. Methods. Sixty-three patients with vascular prostheses infections underwent treatment. Either the infected fragments or the entire prosthesis was removed in all of the patients. Extra-anatomical grafts were implanted in 19 cases. Cryopreserved allogenic arterial grafts were applied for reconstruction in 44 patients. Results. In a 19-patient group with extra-anatomical grafts, two patients died (10.5%). In seven patients (36.8%) relapse symptoms of infection appeared. Primary and secondary patencies of the grafts after 3 years were 31.6% and 52.6% respectively. In a group of 44 patients with allogenic grafts no recurrence of infection was observed. Six patients died (13.6%). Primary and secondary patencies after 3 years were 63.6% and 81.8% respectively. Conclusions. The results reveal the benefits of the allogenic arterial grafts in revascularization in patients with major vascular prostheses infections. The differences in secondary patencies of the implanted allogenic grafts indicate the necessity of an early selection of patients for the complete removal of the infected prosthesis, during a time when patients are in general good health. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of the treatment of infected prosthetic grafts and mycotic aneurysms of the aorta with cryopreserved homografts.Materials and methods: Between April 1994 and May 2002, 15 cryopreserved aortic homografts were used in 13 patients in the thoracic and abdominal aortic position with supplementary omental or pectoral muscle wrapping for infected grafts (n=11), and mycotic aneurysms (n=2) (mean age: 57.5).Results: One patient died due to multiorgan failure and the other due to cerebral hemorrhagia postoperatively (15.38%). Another patient died four months after the operation due to septic arthritis, and coronary heart disease. Ten patients are still alive without evidence of infection (76.92%) during a follow up of 44±23.03 (range 4–71) months.Conclusion: The use of cryopreserved homografts with supplementary omentum and/or muscle flap coverage, assures an anatomical reconstruction with good results in this difficult group of patients. [Copyright &y& Elsevier]

Key Clinical Message Explantation of an infected patent vascular graft does not necessarily require concomitant revascularization procedures. The need for revascularization can be determined by a trial cross-clamping of the graft and clinical assessment of limb perfusion. We report a case of an infected axillofemoral graft transgressing the chest wall in a surgically high risk patient. [ABSTRACT FROM AUTHOR]

The article comments on a study published within the issue which investigated the benefits of self-constructed xenopericardial vascular grafts for the management of graft infections in the ascending aortic position extending to the arch. Findings showed that xenopericardial vascular grafts are always available versus homografts and its size and the length to be constructed can be chosen accordingly.